The Sociodemographic Profile of Women Participating in Mammography Screening in Lower Silesia

NOWOTWORY Journal of Oncology 2017, volume 67, number 2, 89–95 DOI: 10.5603/NJO.2017.0014 © Polskie Towarzystwo Onkologiczne ISSN 0029–540X Original article www.nowotwory.edu.pl The sociodemographic profile of women participating in mammography screening in Lower Silesia Elżbieta Garwacka-Czachor, Adam Maciejczyk, Marek Bębenek Introduction. Female breast cancer is the most common malignancy worldwide. An important element of cancer control involves population-based screening, which aims to reduce related mortality. Screening programs can only serve their purpose if they are long-term and available on a mass scale; accordingly, they are deemed effective as long as they cover at least 70% of the target population. Alarmingly, the coverage of breast cancer screening in Poland is markedly lower. The purpose of this study was to determine the impact of selected sociodemographic factors on the participation of women in mammography screening. Material and methods. The study included a population of Lower Silesian women aged 50 to 69, who participated in mammography screening, and analyzed a total of 32,626 questionnaires collected by means of a diagnostic sur- vey between January 3, 2007 and December 30, 2011. Examined sociodemographic factors included the place of residence, age, educational level, and occupational status. Results. The largest group of screening participants comprised women aged 55 to 59 (30%), from Wrocław and the neighboring districts, with at least secondary education (74%), mostly old-age and disability pensioners (55%). Conclusions. Place of residence, age, education and occupation have a significant impact on the participation of Lower Silesian women in mammography screening. Age and disability pensioners aged 55–59 with at least secondary education are more likely to participate. NOWOTWORY J Oncol 2017; 67, 2: 89–95 Key words: breast cancer, mammography screening, prevention Introduction of the disease. This is helped by population-based screening Breast cancer is the most common malignancy world- programs, whose overarching goal is to reduce related mor- wide, representing a major health issue and a growing social tality rates. Detected early, breast cancer can be treated ef- and economic burden for many developed countries [1–3]. fectively with less radical methods, which directly translates A further systematic rise in its incidence in Europe, including into lower treatment costs. Early detection and treatment Poland, may be expected in the coming future. The trend is also reduce the risk of local relapse and distant metastasis, directly linked to the ageing of the European population and raising survival rates and improving the quality of life [9]. its increased exposure to lifestyle risk factors [4, 5]. Accordingly, the resolutions and recommendations of the In 2012–2013, 1,671,149 new cases were diagnosed European Parliament have repeatedly reiterated the impor- worldwide, including 494,077 in Europe, 17,142 in Poland, tance of screening as the most effective among the available and 1,417 in Lower Silesia. Corresponding standardized tools of secondary prevention [10–13]. incidence rates equaled, respectively: 43.1; 66.5; 51.8, and Adopted in 2005, the Act on Establishing the National 54.3 [6–8]. Cancer Control Program for 2006–2015 laid the groundwork A key role in the struggle against breast cancer is played for the implementation of the Population-Based Early Breast by secondary prevention, i.e. early detection and treatment Cancer Detection Program. The latter was elaborated in Lower Silesian Oncology Center in Wrocław 89 accordance with the guidelines set down in the Council Table I. Women who participated in the Population-Based Early Breast Recommendation of 2 December 2003 on Cancer Screen- Cancer Detection Program at the Lower Silesian Oncology Center ing [11] and provided free mammography to women in the between 2007 and 2011 50–69 age group, which shows the highest incidence rate Year Number of women of breast cancer [14]. 2007 6,237 Screening programs can only serve their purpose if they 2008 5,558 are long-term and available on a mass scale; accordingly, 2009 6,326 they are deemed effective as long as they cover at least 2010 6,788 70% of the target population. This threshold has not yet 2011 7,717 been reached in Poland. According to statistical data for Total 32,626 the first half of 2013, the proportion of eligible women Source: Computer-based Prevention Monitoring System who participated in mammography screening was greater than 50% only in the West Pomeranian and the Lubusz Voivodeships. Everywhere else, it hovered between 37% and 49%; the relevant figure for Lower Silesia was 47% [15]. Statistical analysis Organizers and decision-makers alike are alarmed by the Study groups and variables were summarized by means low participation rate. of descriptive statistics, including the mean, standard de- The purpose of this study was to determine the impact viation, confidence intervals, and percentage distributions. of selected sociodemographic factors on the participation Measurable variables were tested for normality with the of Lower Silesian women in the mammography screening Shapiro-Wilk test and the Fisher test was used to assess the program at the Lower Silesian Oncology Center in Wrocław statistical significance of differences in the distribution of between 2007 and 2011. discrete variables. Changes that occurred in the successive years of the screening program were presented as trends Material and methods and regressions. The impact of age and education on the In 2011, approximately 3 million people lived in Lower willingness to participate the screening program was as- Silesia, more than half of them women (1,513,602). In ad- sessed by the homogeneity of variance test, followed by ministrative terms, Lower Silesia comprises 26 counties and the ANOVA single-factor analysis. The threshold of statistical 3 towns with county rights. A total of 395,852 women were significance was defined as p ≤ 0.05. All calculations were eligible for the Population-Based Early Breast Cancer Detec- performed in Statistica 10 and Microsoft Excel. tion Program run by the Lower Silesian Oncology Center [16]. In the end, 32,626 women aged 50 to 69 took part in the Results program between 3 January 2007 and 30 December 2011. The number of women who participated in the program Data from 32,626 questionnaires were collected and analyzed in successive years is shown in Table I. A slight but systematic in the Computer-Based Prevention Monitoring System [15]. increase in participation can be observed beginning in 2009. Alongside questionnaires, the analysis also included in- formation about the populace covered by mammography Sociodemographic factors screening, introduced into the system by the Lower Silesian Place of residence Voivodeship Coordinating Center for the Early Breat Cancer As shown in Table II, patients from Wrocław (77.9%) Detection Program, as well as statistical data obtained from and the neighboring counties (Wrocław, Oława, Trzebnica, the Central Statistical Office (GUS). Strzelin, Środa Śląska, and Wołów) accounted for 91.9% of Studies conducted in various countries have shown all women who took part in mammography screening at that health behaviors depend on a number of social and the Lower Silesian Oncology Center. demographic factors, such as age, education, marital status, family situation, social class, and material condi- Age tions [17–21]. This article focuses specifically on the age, The largest group (n = 9,889; 30%) comprised women education, occupational status, and place of residence of aged 55 to 59. Respondents between the ages of 50 and 54 screening participants under study. Women aged 50 to represented 29% of the screening group, while the propor- 69 were grouped into 5-year age brackets. Their level of tion of participants in the 65–69 age bracket was the lowest education was described on a scale ranging from incom- (n = 5,023; 16%). Figure 1 shows the distribution of the num- plete primary to a university degree. Occupational status ber of women who took part in the Population-Based Early was defined as the current occupation and the place of Breast Cancer Detection Program in 2009–2011 as a factor residence was listed as the nearest county. of age and testing year, along with relevant trend lines. 90 Table II. Number and percentage of eligible women who participated in the mammography screening by county County, town Number of women, Lk Percentage of women, % Participating Eligible Participating Eligible City of Wrocław 25,201 92,051 77.9 23.3 Wrocław county 1,549 12,600 4.8 3.2 Oława county 802 9,671 2.5 2.4 Trzebnica county 701 9,568 2.2 2.4 Strzelin county 617 5,465 1.9 1.4 Środa Śląska county 425 5,815 1.3 1.5 Wołów county 419 6,011 1.3 1.5 Total: City of Wrocław + neighboring counties 29,714 141,181 91.8 35.7 Other counties, including: 2,648 254,671 8.2 64.3 Świdnica county 377 22,112 1.2 5.6 Dzierżoniów county 311 14,587 1.0 3.7 Ząbkowice country 308 9,121 1.0 2.3 Kłodzko county 226 23,632 0.7 6.0 Oleśnica county 197 12,995 0.6 3.3 Polkowice county 168 7,233 0.5 1.8 Jawor county 139 6,664 0.4 1.7 Głogów county 102 12,695 0.3 3.2 Lubin county 99 15,532 0.3 3.9 Milicz county 98 4,540 0.3 1.1 Bolesławiec county 94 11,621 0.3 2.9 Legnica county 65 6,739 0.2 1.7 City of Wałbrzych 63 10,000 0.2 2.5 Lubań county 58 7,688 0.2 1.9 City of Legnica 58 15,413 0.2 3.9 Zgorzelec county 56 12,654 0.2 3.2 Kamienna Góra county 45 6,056 0.1 1.5 Złotoryja county 44 5,749 0.1 1.5 Wałbrzych county 36 16,775 0.1 4.2 Góra county 34 4,180 0.1 1.1 Jelenia Góra county 25 8,958 0.1 2.3 Lwówek Śląski county 23 6,211 0.1 1.6 City of Jelenia Góra 22 13,516 0.1 3.4 Lower Silesian Voivodeship 32,362 395,852 100 100 Source: table created by the author based on data from the Central Statistical Office and the Computer-Based Prevention Monitoring system During the first three years (2007–2009), an inverse rela- However, in 2010 and 2011, a proportionally higher number tionship could be observed between women’s age and their of older than younger women participated in the screening.

Load more